Nevada State Board of Medical Examiners 

 

Letter from Medical Board to NV Legislators, May 2008

Letter from Governor Gibbons to Medical Board, May 2008

 

May 23, 2008

 

Honorable Sheila Leslie

Chairwoman, Legislative Committee on Health Care

Nevada Assembly

825 Humboldt Street

Reno, NV  89509-2009

 

Honorable Steven A. Horsford

Member, Legislative Committee on Health Care

Nevada Senate

1306 West Craig Road, Ste. E-310

North Las Vegas, NV  89032-0215

 

Dear Chairwoman Leslie and Senator Horsford:

 

In as much as Dr. Javaid Anwar, M.D., the President of the Nevada State Board of Medical Examiners, has recused himself from any consideration or actions in the Endoscopy Center of Southern Nevada case, your letter dated May 12, 2008, has been referred to me, as Acting Chair on these matters, for response.

 

First and foremost, please let me assure you that all members of the Nevada State Board of Medical Examiners (the “Board”), its Executive Director, and its staff share your concern over the very serious crisis that has arisen from practices at the Endoscopy Center of Southern Nevada.

 

Your accusations as to the competency of the Board’s Executive Director, while I am sure are well-intentioned, are based upon inaccurate information.

 

      As you correctly pointed out in your letter, on February 27, 2008, the Southern Nevada Health District informed the public of its findings resulting from procedures performed at the Endoscopy Center of Southern Nevada.  The newspaper report of this release (on February 28, 2008) was the first time the Board and its staff became aware of this crisis.  The Bureau of Licensure and Certification, the Southern Nevada Health District, the Center for Disease Control and the State Nursing Board never contacted the Medical Board prior to the press release of February 27, 2008.   

 

Upon learning of the crisis, the Board’s Executive Director immediately instructed the Chief of the Board’s Investigative Division to begin a full investigation.  Specifically, the Chief of the Investigative Division was told to immediately:  (i) open files on all of the reported cases of Hepatitis C; (ii) issue subpoenas for medical records from the Endoscopy Center of Southern Nevada for all patients infected (the “Board subpoenas”); (iii) obtain lists of all patients treated on the days of the suspected transmission; and (iv) obtain the names and addresses of all employees and owners of the Endoscopy Center of Southern Nevada.  The Board subpoenas were issued that same day (February 28, 2008) and were sent to Las Vegas for service on the Endoscopy Center.  The Board subpoenas, which could not be served on Friday (February 29, 2008) because the clinics/centers were closed by the City of Las Vegas, were served on Monday, March 3, 2008, just 18 working hours after the Board learned of the crisis. 

 

Thereafter, on March 10, 2008, while the Endoscopy Center’s attorneys and employees were working on the response to the Board subpoenas, local law enforcement confiscated all of the Endoscopy Center’s records in connection with its own investigation of possible criminal charges, thereby preventing the Board from obtaining the evidence necessary to initiate action against the medical licenses of the involved physicians.

 

The allegation that the Executive Director refused to comply with a Grand Jury subpoena in order to protect physicians is simply false.  When a Clark County Deputy District Attorney publicly accused the Board of not cooperating with the Grand Jury subpoena, he failed to disclose that the date for compliance with the subpoena had not yet arrived.  At that very time, the Nevada Attorney General’s office was assisting the Board’s Investigative Division in preparation of an appropriate confidentiality agreement with the Las Vegas Metropolitan Police Department so that the Board could fulfill its statutory obligations under to NRS 630.336(4) and to keep confidential some sensitive information, including, but not limited to, the names of patients and complainants.  As you may be aware, such an agreement was timely reached, and law enforcement has already reviewed all files and records sought by the Grand Jury subpoena.  Further, it has received copies of all documents it requested from the Board.

 

From the inception of the Board’s involvement in this tragic matter, its investigators have been participants in the law enforcement task force and have attended each of its weekly meetings.  The Board’s investigators and other participating law enforcement agencies have exchanged evidence and other information in a cooperative spirit. 

 

Both the Board and its staff have, and will continue to, work diligently to uphold our statutory responsibilities in protecting the citizens of Nevada.  The Board is concerned that there are misconceptions regarding the actions that the Board can take to address the Hepatitis C crisis.  I wish to assure you that the Board is doing everything within its legal ability, in a timely and professional manner, to deal with any physicians who are licensees of this Board and are involved in this crisis.

 

The Bureau of Licensure and Certification began its investigation of the Endoscopy Center on January 2, 2008.  By February 28, 2008 (the first day the Board and its staff knew anything about the crisis), the Bureau had already identified improper practices, those practices had been corrected, and the Bureau had approved the Endoscopy Center's plan of corrections and given the Endoscopy Center its permission to continue treatments and procedures.  In addition, the Southern Nevada Health District reported that the transmission of this disease was related to improper anesthesia administration, and not to any medical procedure.  Shortly thereafter, the business licenses of the Endoscopy Center and its affiliated Centers were revoked by both the City and County where these improper practices were occurring. 

 

I am confident that the Board’s Executive Director did not mislead the public or your Committee regarding the Board’s authority to immediately suspend licenses of physicians employed at the Endoscopy Center.  Also, the Board’s efforts to ensure that its statutory obligations concerning confidentiality were met, while not obstructing law enforcement’s progress, should be commended, not criticized.  There simply has been no abuse of discretion in handling this matter by any member of the Board’s staff. 

 

The Board, through its Executive Director and its staff, has pursued the investigation in this matter with the utmost urgency, integrity and professionalism, and will continue to do so.  The Board’s Executive Director has vast experience and knows the law well.  Further, he diligently discusses and obtains input from Board officers and from the Nevada Attorney General’s office prior to taking any action on behalf of the Board. 

 

In attempting to determine what remedies are available to the Board, its Executive Director and the Board President, before the President's recusal, were in constant communication with the Nevada Attorney General’s office as well as the Board's legal staff.  With respect to the Board taking any action to summarily suspend the licenses of those physicians who were allegedly involved in the Hepatitis C outbreak, we could not legally pursue emergency summary license suspensions since the dangerous and improper conduct had been corrected and the Endoscopy Center (and affiliated Centers) had been closed due to the loss of its business license.  All of the foregoing has been discussed with me as the acting Board chair regarding this investigation.  As you are aware, any action by the Board pursuant to NRS 233B.127 requires that it make a finding that public health, safety or welfare imperatively require immediate emergency action.  As I am sure you can now appreciate, the Board simply did not have sufficient evidence to support such a finding, and since the report of the Health District of Southern Nevada stated that the cause of the transmission came from the administration of anesthesia by CRNAs, there was not specific evidence to prove improper medical conduct against any doctor.  Consequently, based on these facts, the Nevada Attorney General's Office agreed there was not sufficient legal ground to pursue summary suspension under NRS 233B.127.  Thus, the Board’s Executive Director correctly advised the Legislative Committee on Health Care (on April 21, 2008) that the Board did not have the authority to pursue summary suspensions. 

 

The Board has and continues to engage in an aggressive investigation into this matter and is obtaining evidence to support its legal ability to take disciplinary action against any and all of the physicians who may have been involved in the tragic outbreak of Hepatitis C, despite our efforts being hindered by law enforcement’s understandable seizure of all medical records and other evidence from the Endoscopy Center. 

 

Please note that the Board effectuated the voluntary agreement for one of the principal owners of the Endoscopy Center to cease the practice of medicine in a relatively short period of time after learning of the crisis and has actively pursued injunctive relief against certain of its licensees (pursuant to NRS 630.388) by working through the Nevada Attorney General’s Office; which, as you know, has resulted in two physicians being enjoined from the practice of medicine in Nevada by the Eighth Judicial District Court.

 

Finally, as a point of fact, the Board is the only health licensing agency that has actually filed a disciplinary complaint against an involved licensee.  The six Certified Registered Nurse Anesthetists voluntarily surrendered their licenses during the pendency of the investigation into the outbreak, but no disciplinary action has been filed against any of them, or against any of the other nurse licensees who worked at the Endoscopy Center.

 

As I hope you can appreciate, the Board cannot respond in this letter to all the media reports; some of which are true, some of which have been taken out of context, and some of which are factually incorrect.  Neither the Board nor its staff has ever interfered with or otherwise delayed any law enforcement investigation of this matter.  Currently, it is my understanding that law enforcement has not even started its review of the evidence it confiscated from the Endoscopy Centers on March 10, 2008. 

 

The Board continues to uphold its mandate to ensure the safety of the public in all that it does.  Please rest assured, however, that the Board’s vigorous investigation into this matter, while fully cooperating with law enforcement, remains its number one priority. 

 

Sincerely,

 

 Donald H. Baepler, Ph.D., D.Sc.

Secretary-Treasurer

Nevada State Board of Medical Examiners

 

May 29, 2008

 

Javaid Anwar, M.D.

President

Nevada Board of Medical Examiners

1105 Terminal Way, Suite 301

Reno, Nevada 89502

 

Dear Dr. Anwar,

 

On April 2, 2008 three temporary members were appointed to the State Board of Medical Examiners (“Board”) to replace Board members who had conflicts of interest with Dr. Dipak Desai or with the Endoscopy Center of Southern Nevada. These temporary members were appointed so that a full, non-conflicted, nine-member Board would be available to investigate the critical issue of public health and safety relating to the Hepatitis C infections originating out of Clark County.

 

It is our understanding that as of this time neither you nor Board staff has even contacted the three temporary members.  The Hepatitis C infection from the Endoscopy Center of Southern Nevada is a health care crisis.  Public confidence in the health care system has been eroded.  Nevadans must know that the State is taking swift and decisive action to protect the health and safety of its citizens.  The fact that the Board has not even held a hearing to inform the public and its temporary members of the Board’s plan to investigate physicians involved in this matter is simply inexcusable.       

 

At this point, we see no alternative but to demand an immediate and detailed report of all actions the Board has taken to date to address the role any Nevada physicians may have played in the outbreak.   Also, please provide a description of the Board’s future plans to investigate any Nevada physicians involved in the outbreak. Please provide this information by the close of business on June 2, 2008.

 

We also request that the Board assign appropriate and qualified Board staff members to oversee the pertinent proceedings. The Executive Director of the Board has demonstrated an unwillingness to vigorously handle the matter.

 

It is essential that the Board and Board staff promptly conduct the work they are charged with to ensure public safety and to restore the public’s faith in our healthcare system. It is clear in state law that the Board’s ultimate responsibility is to ensure the safety of the public. We expect that the Board will follow through on this charge without further delay.  Please remember that NRS 630.003 grants authority to the Board of Medical Examiners and charges them to always consider the protection and benefit of the public.

 

We realize you have recused yourself from matters concerning the Endoscopy Center, but as President of the Board it is incumbent on you to see that those matters are nonetheless expeditiously processed by the Board and Board staff.

 

We look forward to hearing from you and your staff.

 

Sincerely,

JIM GIBBONS

Governor

SENATOR RANDOLPH TOWNSEND

Chairman, Senate Commerce and Labor

 

SENATOR JOSEPH HECK, D.O.

Clark District 5

 

SENATOR STEVEN HORSFORD

Clark District 4

 

ASSEMBLYWOMAN SHEILA LESLIE

Washoe District 27

  

CC:      Drennan A. Clark, J.D., Executive Director

            Sohail U. Anjum, M.D., Board Member 

            Charles N. Held, M.D., Board Member

            Cindy Lamerson, M.D., Board Member

            S. Daniel McBride, M.D., Board Member

            Benjamin J. Rodriguez, M.D., Board Member

            Jean Stoess, M.A., Board Member

            Renee West, Board Member

            Ronald Kline, M.D., Temporary Board Member

            Beverly Neyland, M.D., Temporary Board Member

            Robert Wiencek, Jr., M.D., Temporary Board Member

            Senator William Raggio

            Speaker Barbara Buckley

            Assemblywoman Heidi Gansert

            Catherine Cortez Masto, Attorney General

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